Healthcare Provider Details

I. General information

NPI: 1750377123
Provider Name (Legal Business Name): WASHINGTON N & R, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 10/31/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W 5TH ST
WASHINGTON MO
63090-2306
US

IV. Provider business mailing address

324 W 5TH ST
WASHINGTON MO
63090-2306
US

V. Phone/Fax

Practice location:
  • Phone: 636-239-7848
  • Fax: 636-239-0028
Mailing address:
  • Phone: 636-239-7848
  • Fax: 636-239-0028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030532
License Number StateMO

VIII. Authorized Official

Name: JAMES C LINCOLN
Title or Position: MEMBER
Credential:
Phone: 573-746-7100